Peer-reviewed article
Association between anthropometric criteria and body composition among children aged 6–59 months with uncomplicated severe acute malnutrition: A prospective cohort study from South Sudan
Gabriele Rossi, Rachel M. Creighton, Patricia Ayebazibwe, Santo Garang, Mohammed Kamruzzaman et al. ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at children aged 6 to 59 months being treated for severe acute malnutrition in South Sudan. It compared children diagnosed using mid-upper arm circumference, weight-for-height, or both, and measured their body composition at admission and discharge. Children diagnosed by MUAC alone or by both criteria were younger and more stunted at the start. During treatment, children diagnosed by weight-for-height gained mostly lean tissue and recovered fastest, while those diagnosed by MUAC alone gained mostly fat with little lean tissue gain. The authors say this suggests that standard weight and height measurements alone may not show the full picture of a child's recovery.
Key points
- Children diagnosed by MUAC or combined criteria were younger and more stunted at admission than those diagnosed by weight-for-height alone.
- The combined-criteria group showed the most severe deficits in anthropometry, fat mass index, and phase angle at admission.
- Children diagnosed by weight-for-height recovered fastest, gaining mostly fat-free mass (82% of weight gain).
- Children diagnosed by MUAC alone gained mainly fat mass (78% of weight gain) with little fat-free mass gain and a decline in phase angle.
- The authors conclude that anthropometric recovery alone may not capture true recovery patterns across different diagnostic groups.
Limitations
The study is exploratory and observational with no comparison to an alternative treatment, and it does not follow children after discharge to see if these body-composition differences affect later health outcomes.
Abstract
BACKGROUND: Severe acute malnutrition (SAM) is diagnosed based on bilateral edema, mid‑upper arm circumference (MUAC), and/or weight‑for‑height z‑score (WHZ). These criteria do not fully overlap and may identify children with distinct biological and clinical profiles. Understanding how children with SAM identified by different criteria differ in body composition during outpatient therapeutic program (OTP) treatment may help inform treatment and post‑discharge practices. METHODS: We conducted a prospective cohort study of children aged 6-59 months with uncomplicated SAM admitted by MUAC only (MUAC group), WHZ only (WHZ group), or combined MUAC and WHZ criteria (Combined group) in Aweil Centre, South Sudan. Anthropometry, triceps skinfold thickness, and bioelectrical impedance analysis were collected at admission (n = 194) and discharge (n = 127). Fat mass (FM), fat‑free mass (FFM), fat mass index (FMI), fat‑free mass index (FFMI), total body water percentage (TBW), and phase angle (PhA) were assessed. Between‑group differences and within‑child changes were analyzed using linear mixed effects models adjusted for age and sex. RESULTS: At admission, children in the MUAC and Combined groups were younger and more stunted, with the Combined group showing the most severe deficits across anthropometry, FMI, and PhA. During treatment, the WHZ group exhibited the fastest recovery, with predominantly FFM accretion (82% of weight gain) and the largest increases in FFMI. In contrast, the MUAC group accumulated mainly FM (78% of weight gain) with minimal FFM gain and a decline in PhA, while the Combined group showed mixed FM and FFM recovery patterns. CONCLUSIONS: Children admitted for outpatient SAM treatment by MUAC, WHZ, or combined criteria appeared to follow different recovery trajectories despite meeting standard anthropometric discharge thresholds. Body‑composition and impedance indicators suggested heterogeneity in tissue gain patterns and vulnerability profiles across admission groups, particularly in the MUAC and Combined groups. While exploratory, these findings suggest that anthropometric recovery alone may not uniformly capture the full recovery pattern across SAM admission groups, warranting the need for longitudinal studies evaluating whether body-composition differences at discharge predict subsequent clinical outcomes and post-discharge vulnerability.